CARROLL COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CARROLL COUNTY MEMORIAL HOSPITAL (EIN 44-0629397)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-12
- IRS object ID
- 202341329349307724
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-12T15:35:11-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440629397 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARR | BusinessNameControlTxt |
| Phone | 6605421695 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 N JEFFERSON STREET | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SCOTT THORESON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6605421695 | PhoneNum |
| Signature | 2023-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SCOTT | PersonFirstNm |
| Person Last | THORESON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MEGAN L KOZIOL CPA | PreparerPersonNm |
| PTIN | P01544037 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2023-05-12 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SCOTT THORESON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 N JEFFERSON STREET | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $42,391,224 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CARROLLCOUNTYHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1957 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | CARROLL COUNTY MEMORIAL HOSPITAL IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 280 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,446,588 | PYContributionsGrantsAmt |
| CY Contributions Grants | $412,109 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,637,266 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $41,685,369 | CYProgramServiceRevenueAmt |
| PY Investment Income | $38,656 | PYInvestmentIncomeAmt |
| CY Investment Income | $97,056 | CYInvestmentIncomeAmt |
| PY Other Revenue | $180,687 | PYOtherRevenueAmt |
| CY Other Revenue | $131,623 | CYOtherRevenueAmt |
| PY Total Revenue | $43,303,197 | PYTotalRevenueAmt |
| CY Total Revenue | $42,326,157 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $286,269 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,740,483 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,094,898 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,778,720 | PYOtherExpensesAmt |
| CY Other Expenses | $20,197,326 | CYOtherExpensesAmt |
| PY Total Expenses | $39,805,472 | PYTotalExpensesAmt |
| CY Total Expenses | $40,292,224 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,497,725 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,033,933 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $46,592,122 | TotalAssetsBOYAmt |
| Total Assets EOY | $41,868,787 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,912,423 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,409,202 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $29,679,699 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $31,459,585 | NetAssetsOrFundBalancesEOYAmt |
| Mission | CARROLL COUNTY MEMORIAL HOSPITAL IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $35,758,525 | ExpenseAmt |
| Revenue | $41,702,186 | RevenueAmt |
| Desc | ACUTE CARE HOSPITAL ORGANIZED TO PROVIDE INPATIENT AND OUTPATIENT CARE TO AREA RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. | Desc |
| Total Program Service Expenses | $35,758,525 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 280 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LESLEY DELANEY | PersonNm |
| Phone | 6605421695 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 NORTH JEFFERSON ST | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| TIMOTHY REID MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $317,573 | $0 | $56,124 | |||
| JENNIFER POSTON | |||||||||
| PRESIDENT | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JODI AHNEFELD | |||||||||
| VICE PRESIDENT | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MATT LOCK | |||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| TOM ANDERSON | |||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| ANNA BARLOW | |||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| KEVIN BROWN | |||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SHELLY KUSSMAN | |||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| WADE MERTENSMEYER | |||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| KIM RITCHHART | |||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RANDALL BARRY | |||||||||
| VICE PRESIDENT THRU 1/2022 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| REX BUHRMESTER | |||||||||
| PRESIDENT THRU 1/2022 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SCOTT THORESON | |||||||||
| CEO | 39.00 | 1.00 | $141,824 | $0 | $10,272 | Yes (X) | |||
| AMY IRELAND | |||||||||
| CFO | 39.00 | 1.00 | $131,387 | $0 | $42,972 | Yes (X) | |||
| RICHARD SMITH MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $549,782 | $0 | $34,279 | Yes (X) | |||
| GREGORY HUBBARD MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $543,573 | $0 | $32,048 | Yes (X) | |||
| ANDREW HORINE MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $457,241 | $0 | $43,867 | Yes (X) | |||
| JEREMY STAYTON MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $456,858 | $0 | $38,829 | Yes (X) | |||
| GREGORY STAFFORD PA | |||||||||
| PHYSICIAN'S ASSISTANT | 40.00 | 0.00 | $266,367 | $0 | $21,592 | Yes (X) | |||
| JEFF TINDLE | |||||||||
| FORMER CEO THRU 6/2021 | 40.00 | 0.00 | $180,762 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,045,367 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $279,983 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HOSPITAL CARE CONSULTANTS | |||||
| 17304 PRESONT RD SUITE 1400 | DALLAS | TX | 75272 | HOSPITALIST SERVICES | $679,345 |
| CERNER CORPORATION | |||||
| PO BOX 959159 | ST LOUIS | MO | 63195 | SOFTWARE & CONTRACT EMPLOYEES | $642,458 |
| BERGANKDV | |||||
| PO BOX 735496 | DALLAS | TX | 75373 | IT SERVICES | $567,705 |
| PSYCHIATRIC MEDICAL CARE LLC | |||||
| PO BOX 734606 | DALLAS | TX | 75373 | MEDICAL SERVICES | $374,762 |
| HAVE A NICE DAY ANESTHESIA | |||||
| 2106 WOODCREST DRIVE | CHILLICOTHE | MO | 64601 | ANESTHESIA SERVICES | $341,005 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $412,109 | GovernmentGrantsAmt |
| Total Contributions | $412,109 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID | 624100 | $25,099,301 | $25,099,301 |
| NET PATIENT SERVICE REVENUE | 624100 | $15,250,153 | $15,250,153 |
| 340B DRUG PRICING PROGRAM | 624100 | $1,070,420 | $1,070,420 |
| ELECTRONIC HEALTH RECORD INCENTIV | 624100 | $159,729 | $159,729 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $105,766 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $105,766 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $41,685,369 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $86,660 | TotalRevenueColumnAmt |
| Exclusion | $86,660 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $70,350 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $53,533 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $16,817 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,817 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,817 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $21,930 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $11,534 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $10,396 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,396 | TotalRevenueColumnAmt |
| Exclusion | $10,396 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA | Desc |
| Business | 722514 | BusinessCd |
| Total Revenue Column | $114,806 | TotalRevenueColumnAmt |
| Exclusion | $114,806 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $114,806 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,326,157 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $41,702,186 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $211,862 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $700,152 | TotalAmt |
| Program Services | $373,697 | ProgramServicesAmt |
| Management And General | $326,455 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,369,611 | TotalAmt |
| Program Services | $12,591,937 | ProgramServicesAmt |
| Management And General | $1,777,674 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $765,629 | TotalAmt |
| Program Services | $667,990 | ProgramServicesAmt |
| Management And General | $97,639 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,259,506 | TotalAmt |
| Program Services | $3,700,439 | ProgramServicesAmt |
| Management And General | $559,067 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,547 | TotalAmt |
| Management And General | $2,547 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,112,551 | TotalAmt |
| Program Services | $8,689,757 | ProgramServicesAmt |
| Management And General | $422,794 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,933 | TotalAmt |
| Program Services | $38,812 | ProgramServicesAmt |
| Management And General | $30,121 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $987,153 | TotalAmt |
| Program Services | $634,949 | ProgramServicesAmt |
| Management And General | $352,204 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $599,648 | TotalAmt |
| Program Services | $550,532 | ProgramServicesAmt |
| Management And General | $49,116 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $815,951 | TotalAmt |
| Program Services | $639,682 | ProgramServicesAmt |
| Management And General | $176,269 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,201 | TotalAmt |
| Program Services | $98,019 | ProgramServicesAmt |
| Management And General | $24,182 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $386,172 | TotalAmt |
| Program Services | $271,517 | ProgramServicesAmt |
| Management And General | $114,655 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,673,798 | TotalAmt |
| Program Services | $2,173,460 | ProgramServicesAmt |
| Management And General | $500,338 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,008 | TotalAmt |
| Program Services | $159,865 | ProgramServicesAmt |
| Management And General | $32,143 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,152,662 | $2,152,536 | $126 |
| IMPLICIT PRICE CONCESSI | $1,588,236 | $1,588,236 | |
| MISC | $679,106 | $613,236 | $65,870 |
| 340(B) PHARMACY EXPENSE | $629,181 | $629,181 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,179 | TotalAmt |
| Program Services | $184,680 | ProgramServicesAmt |
| Management And General | $2,499 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,292,224 | TotalAmt |
| Program Services | $35,758,525 | ProgramServicesAmt |
| Management And General | $4,533,699 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $972 | BOYAmt |
| EOY | $28,492 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,186,113 | BOYAmt |
| EOY | $14,747,469 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,093,321 | BOYAmt |
| EOY | $5,046,362 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $538,402 | BOYAmt |
| EOY | $840,128 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $381,665 | BOYAmt |
| EOY | $477,641 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $42,435,992 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $26,047,738 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,731,107 | BOYAmt |
| EOY | $16,388,254 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,327,201 | BOYAmt |
| EOY | $1,921,538 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $905,637 | BOYAmt |
| EOY | $1,178,921 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,427,704 | BOYAmt |
| EOY | $1,239,982 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,592,122 | BOYAmt |
| EOY | $41,868,787 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,457,154 | BOYAmt |
| EOY | $3,449,099 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,140,824 | BOYAmt |
| EOY | $6,945,703 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $314,445 | BOYAmt |
| EOY | $14,400 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,912,423 | BOYAmt |
| EOY | $10,409,202 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,190,136 | BOYAmt |
| EOY | $30,895,157 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $489,563 | BOYAmt |
| EOY | $564,428 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,679,699 | BOYAmt |
| EOY | $31,459,585 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,592,122 | BOYAmt |
| EOY | $41,868,787 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,033,933 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$328,912 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $74,865 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,894 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,894 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE AMOUNT OF SCHEDULE C, PART II-B, LINE 1I REPRESENTS THE LOBBYING PORTION OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $268,115 | OtherCostOrOtherBasisAmt |
| Book Value | $268,115 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,424,842 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,378,776 | DepreciationAmt |
| Book Value | $13,046,066 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,865,887 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,372,945 | DepreciationAmt |
| Book Value | $2,492,942 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,877,148 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,296,017 | DepreciationAmt |
| Book Value | $581,131 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,388,254 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RENTAL DEPOSITS | Desc |
| Amt | $14,400 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $14,400 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $40,537,407 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$328,912 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $128,398 | OtherRevenueAmt |
| Revenue Not Reported | -$200,514 | RevenueNotReportedAmt |
| Revenue Subtotal | $40,737,921 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,588,236 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,588,236 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $42,326,157 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $38,757,521 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $53,533 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $53,533 | ExpensesNotReportedAmt |
| Expenses Subtotal | $38,703,988 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,588,236 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,588,236 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $40,292,224 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2022 AND 2021, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN BENEFICIAL INTEREST OF FOUNDATION 74,865. RENTAL EXPENSES 53,533. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 1,588,236. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 53,533. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 1,588,236. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | 0 | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $253,305 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $253,305 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00650 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,353,409 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,415,626 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $937,783 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02420 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,606,714 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,415,626 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,191,088 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03070 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,943 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,943 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $402,187 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $402,187 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01040 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,050 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,050 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $437,180 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $437,180 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01130 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,043,894 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,415,626 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,628,268 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04200 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,588,236 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,738,429 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,014,203 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $724,226 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 NORTH JEFFERSON ST | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 210-58 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | PHYSICIAN CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.CARROLLCOUNTYHOSPITAL.ORG/COMMUNITY | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.CARROLLCOUNTYHOSPITAL.ORG/COMMUNITY | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CARROLL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 3J: KEY FINDINGS INCLUDE: SUBSTANCE ABUSE, MENTAL HEALTH, OBESITY, UNINSURED/UNDERINSURED SERVICES, AFFORDABLE HOUSING, AND VACCINATION EDUCATION |
| CARROLL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: CARROLL COUNTY MEMORIAL HOSPITAL INTERVIEWD HOSPITAL STAKEHOLDERS, COMMUNITY LEADERS, AND BUSINESS OWNERS TO ASSESS PUBLIC PERCEPTIONS OF THE COUNTY'S HEALTH STATUS AND UNMET NEEDS. THE INFORMATION GATHERED FROM THE INTERVIEWS PLAYED AN INSTRUMENTAL PART IN THE DEVELOPMENT OF AN IMPLEMENATATION PLAN TO ADDRESS THE NEEDS OF THE COMMUNITY. |
| CARROLL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: CARROLL COUNTY HAS AN IMPLEMENATION PLAN THAT WE FOLLOW TO MEET THE NEEDS IDENTIFIED IN THE CHNA. THREE PRIORITY AREAS OF SIGNIFICANT NEED WERE IDENTIFIED: SUBSTANCE ABUSE/MENTAL HEALTH AND OBESITY. EACH OF THESE WERE ADDRESSED IN THE IMPLEMENTATION STRATEGY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - JEFFERSON MEDICAL GROUP | ||||
| 1502 N JEFFERSON | CARROLLTON | MO | 64633 | RURAL HEALTH CLINIC |
| 2 - JEFFERSON MEDICAL GROUP - NORBORNE | ||||
| 105 EAST 2ND STREET | NORBONNE | MO | 64668 | RURAL HEALTH CLINIC |
| 3 - JEFFERSON MEDICAL GROUP - HALE | ||||
| 221 ELM STREET | HALE | MO | 64643 | RURAL HEALTH CLINIC |
| 4 - CCMH HOME HEALTH | ||||
| 1502 N JEFFERSON | CARROLLTON | MO | 64633 | HOME HEALTH AGENCY |
| 5 - JEFFERSON MEDICAL GROUP - BRUNSWICK | ||||
| 807 EAST BROADWAY STREET | BRUNSWICK | MO | 65236 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | DISCOUNTED OR FREE CARE IS BASED OFF OF 200% OF FEDERAL POVERTY GUIDELINES. ALSO, IN CATASTROPHIC MEDICAL CASES WHERE THE PATIENTS MEDICAL BILLS EXCEED 20% OF THEIR GROSS INCOME, PLUS ASSETS FOR THE YEAR. |
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED PARTY. |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. |
| PART I, LINE 7G: | NO PHYSICAN CLINIC COSTS ARE INCLUDED. |
| PART I, LN 7 COL(F): | THE AMOUNT OF IMPLICIT PRICE CONCESSIONS EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,588,236. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE ORGANIZATION DOES NOT REPORT ANY COMMUNITY BUILDING ACTIVITIES. |
| PART III, LINE 2: | THE HOSPITAL DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR GOODS AND SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE HOSPITAL'S POLICY, AND OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. THE HOSPITAL DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS |
| PART III, LINE 3: | THE AMOUNT OF IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS BASED ON SELF-PAY ONLY PATIENTS COVERED BY MEDICAID HMOS AND THE PERCENT OF THE ELIGIBLE MEDICAID AND MEDICAID HMO PATIENTS DIVIDED BY TOTAL IMPLICIT PRICE CONCESSIONS THIS PERCENTAGE IS THEN MULTIPLIED BY SELF-PAY PATIENTS (PRIM HEALTH PLAN). THE TWO ESTIMATES ARE THEN COMBINED. NONE OF THIS AMOUNT IS CONSIDERED COMMUNITY BENEFIT. |
| PART III, LINE 4: | THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 10, AND 11 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "PATIENT FINANCIAL ASSISTANCE." |
| PART III, LINE 8: | CCMH BELIEVES THAT MEDICARE SHORTFALLS SHOULD QUALIFY AS A COMMUNITY BENEFIT COST IF THE MEDICARE BENEFICIARY IS INDIGENT. THIS WAS NOT APPLICABLE TO THE 2021 RETURN AS LINE 7 REPORTS A SURPLUS IN 2021. |
| PART III, LINE 9B: | EACH PATIENT IS PROVIDED WITH PAYMENT INFORMATION IN CLEAR, EASY-TO-UNDERSTAND LANGUAGE. CCMH CHECKS ON PUBLIC-ASSISTANCE PROGRAMS TO SEE IF THE PATIENT QUALIFIES. THE HOSPITAL OFFERS DISCOUNTS ON CHARGES TO UNDERINSURED PATIENTS WHEN POSSIBLE. |
| PART VI, LINE 2: | CARROLL COUNTY MEMORIAL HOSPITAL RELIES ON INTERACTION WITH LOCAL CARE AGENCIES AS WELL AS FEEDBACK FROM PATIENTS AND PRIMARY SERVICE AREA RESIDENTS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY. |
| PART VI, LINE 3: | CCMH PROVIDES EACH PATIENT WITH A LETTER THAT CLEARLY STATES PAYMENT INFORMATION IN AN EASY TO UNDERSTAND LANGUAGE. THE HOSPITAL INFORMS PATIENTS PROMPTLY ABOUT THE CHARGE FOR ANY ITEM OR SERVICE PROVIDED. THE LETTER INFORMS THE PATIENT THAT IF THEY ARE NOT ABLE TO PAY THEIR HOSPITAL BILL THERE ARE PROGRAMS THAT MAY HELP ALLEVIATE THEIR BURDEN. IF PROMPTED, THE HOSPITAL WILL CHECK FOR PUBLIC ASISTANCE OR CHARITY CARE PROGRAMS TO SEE IF THE PATIENT QUALIFIES |
| PART VI, LINE 4: | CARROLL COUNTY MEMORIAL HOSPITAL IS LOCATED IN CARROLLTON, MISSOURI. THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF CARROLLTON AND THE SURROUNDING AREAS OF CARROLL COUNTY. CARROLL COUNTY MEMORIAL HOSPITAL OPERATES THREE SATELLITE CLINICS LOCATED IN BRUNSWICK, HALE AND NORBORNE. CARROLL COUNTY HAS A POPULATION OF APPROXIMATELY 8,679 RESIDENTS, WITH 35.5% OF THE RESIDENTS LIVING IN URBAN AREAS AND 64.5% LIVING IN RURAL AREAS. THE MEDIAN ANNUAL HOUSEHOLD INCOME FOR CARROLL COUNTY IS APPROXIMATELY $43,583. |
| PART VI, LINE 5: | CARROLL COUNTY MEMORIAL HOSPITAL WAS ORIGINALLY FOUNDED BY LOCAL CITIZENS FOCUSED ON HEALTHCARE FOR CARROLL COUNTY AND THE SURROUNDING AREA. CCMH IS "DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE AND UNDERSTANDS COMMUNITY HEALTH GOES BEYOND THE WALLS OF THE HOSPITAL.CCMH CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. THE ASSESSMENT HELPS THE HOSPITAL SET GOALS TO IMPROVE THE HEALTH STATUS OF ITS PATIENTS AND THE COMMUNITY. CCMH'S CURRENT GOALS ARE FOCUSED ON LIFESTYLE BEHAVIORS, ACCESS TO CARE, AND MENTAL HEALTH FOR YOUTH AND ADULTS.CCMH PARTICIPATES IN THE CARROLL COUNTY COALITION FOCUSING ON MENTAL HEALTH AND SUBSTANCE USE DISORDER. CCMH HAS IMPLEMENTED THE FOLLOWING STRATEGIES TO ADDRESS MENTAL HEALTH INITIATIVES:1. INCREASE AWARENESS OF COMMUNITY RESOURCES THROUGH A COMMUNITY RESOURCE GUIDE.2. COLLABORATE WITH LOCAL SCHOOL DISTRICTS TO REVIEW CURRENT METHODS OF IDENTIFYING YOUTH AT-RISK AND OFFER COLLABORATIVE ASSISTANCE.3. PROVIDE RESOURCES TO SUPPORT AND ASSIST WITH PREVENTION AND TREATMENT OF SUBSTANCE USE DISORDER.4. PROVIDE PSYCHIATRIC AND THERAPY SERVICES.CCMH ALSO WORKS TO IMPROVE ACCESS TO BASIC AND PREVENTATIVE CARE ESPECIALLY FOR THE UNINSURED AND UNDER-INSURED THROUGH THE FOLLOWING STRATEGIES:1. PROVIDE COMMUNITY EDUCATION AND AWARENESS.2. IMPROVE ACCESSIBILITY THROUGH SATELLITE CLINICS IN SURROUNDING COMMUNITIES.3. SUPPORT THE NURSE NAVIGATOR PROGRAM TO ASSIST PATIENTS WITH GUIDANCE THROUGHOUT THEIR HEALTHCARE JOURNEY.4. EXPAND VIRTUAL VISITS.THE HOSPITAL ALSO HOUSES THE CCMH WELLNESS CENTER, A UNIQUE REHAB AND FITNESS CENTER, WHICH INCORPORATES AN INDOOR POOL, SAUNA, HOT TUB, INDOOR 1/16-MILE WALKING TRACK, AND STATE OF THE ART FITNESS EQUIPMENT WITH CERTIFIED THERAPISTS AND TRAINERS PROVIDING THERAPY AND PROGRAMS TO RESIDENTS OF CARROLL COUNTY AND THE SURROUNDING AREAS. |
| PART VI, LINE 6: | THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MO |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RICHARD SMITH MD | ||||||||||||||
| PHYSICIAN | $444,627 | $0 | $104,690 | $0 | $465 | $0 | $23,200 | $0 | $11,079 | $0 | $584,061 | $0 | $0 | $0 |
| GREGORY HUBBARD MD | ||||||||||||||
| PHYSICIAN | $541,693 | $0 | $500 | $0 | $1,380 | $0 | $0 | $0 | $32,048 | $0 | $575,621 | $0 | $0 | $0 |
| ANDREW HORINE MD | ||||||||||||||
| PHYSICIAN | $390,754 | $0 | $66,321 | $0 | $166 | $0 | $23,200 | $0 | $20,667 | $0 | $501,108 | $0 | $0 | $0 |
| JEREMY STAYTON MD | ||||||||||||||
| PHYSICIAN | $425,219 | $0 | $31,171 | $0 | $468 | $0 | $7,076 | $0 | $31,753 | $0 | $495,687 | $0 | $0 | $0 |
| TIMOTHY REID MD | ||||||||||||||
| PHYSICIAN | $265,325 | $0 | $52,051 | $0 | $197 | $0 | $23,200 | $0 | $32,924 | $0 | $373,697 | $0 | $0 | $0 |
| GREGORY STAFFORD PA | ||||||||||||||
| PHYSICIAN'S ASSISTANT | $232,388 | $0 | $33,464 | $0 | $515 | $0 | $21,592 | $0 | $0 | $0 | $287,959 | $0 | $0 | $0 |
| JEFF TINDLE | ||||||||||||||
| FORMER CEO THRU 6/2021 | $180,762 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $180,762 | $0 | $0 | $0 |
| AMY IRELAND | ||||||||||||||
| CFO | $119,691 | $0 | $11,600 | $0 | $96 | $0 | $10,618 | $0 | $32,354 | $0 | $174,359 | $0 | $0 | $0 |
| SCOTT THORESON | ||||||||||||||
| CEO | $141,331 | $0 | $0 | $0 | $493 | $0 | $0 | $0 | $10,272 | $0 | $152,096 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 5 | FormAndLineReferenceDesc |
| Explanation | A PORTION OF PHYSICIAN COMPENSATION WAS CALCULATED QUARTERLY USING A PERCENTAGE OF REIMBURSEMENT. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE, COMPRISED OF THE ELECTED OFFICERS AND TWO OTHER MEMBERS OF THE BOARD APPOINTED BY THE PRESIDENT, HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | A SEPARATE ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE FORM 990 WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD SETS THE CONFLICT OF INTEREST POLICY AND ADMINISTRATION IS CHARGED WITH ASSURING THAT COMPLIANCE IS MAINTAINED. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY AND EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST DISCLOSURE FORM. IF A CONFLICT ARISES THE CONFLICTED PERSON DOES NOT TAKE PART IN THE VOTE ON THE ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD CONDUCTS AN ANNUAL SALARY REVIEW FOR THE CEO. THE BOARD APPROVES THE AMOUNT OF COMPENSATION. THE LAST REVIEW WAS CONDUCTED IN 2022. ALL OTHER MANAGEMENT POSITIONS ARE HIRED, REVIEWED, AND MONITORED BY THE CEO AND LEADERSHIP TEAM. COMPENSATION REVIEWS OCCUR ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PHARMACY EXPENSE: PROGRAM SERVICE EXPENSES 2,542,277. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,542,277. OTHER CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 6,147,480. MANAGEMENT AND GENERAL EXPENSES 422,794. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,570,274. |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST OF FOUNDATION 74,865. |
| PART XII, LINE 2C | THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL FDN | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 N JEFFERSON ST | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 463696048 | EIN |
| Primary Activities | SUPPORT | PrimaryActivitiesTxt |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |